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<section class="box6">
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		<h1>医院快速预约挂号系统</h1>
		<h2>
			在线预约，免挂号费，优先就诊
			<span>(所填信息已进入加密处理)</span>
		</h2>
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					<div class="box6_mar">
						<div class="box6_left fl">您的姓名：</div>
						<div class="box6_con fl">
							<label for="name"></label>
							<input type="text" name="name" id="name" class="disi"></div>
						<div class="names fl">
							<span>*</span>
							您的真实姓名
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						<div class="box6_left fl">联系电话：</div>
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							<label for="phone"></label>
							<input type="text" name="phone" id="phone" class="disi"></div>
						<div class="names fl">
							<span>*</span>
							为方便联系，
							<br>请留下您的联系电话</div>
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					<div class="box6_mar">
						<div class="box6_left fl">病情描述：</div>
						<div class="box6_right fl">
							<label for="phone"></label>

							<textarea name="desc" rows="8" cols="45" class="dis" id="desc"></textarea>
							<div class="clear"></div>
						</div>
						<div class="box6_wid">
							<input type="button" name="sub_btn" id="sub_btn" value="点击提交" class="box6_ti sub_btn">

							<input type="reset" name="button2" id="button2" value="重填" class="box6_tian"></div>

						<div class="box6_ren">
							已有
							<span>55人</span>
							成功挂号
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		广州中医药大学金沙洲医院
		<br>
		健康热线：020-81659126
		<br>
		QQ在线咨询：1203333210
		<br>
		<a href="http://www.miitbeian.gov.cn/">粤ICP备15031204号-3</a>
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				<p>您好，这里是广州中医药大学金沙洲医院(乳腺科)，预约享受免费B超检查</p>
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